CARE HOMES FOR OLDER PEOPLE
Ashcroft House Fairview Close Wilderness Hll Cliftonville Kent. CT9 2QE Lead Inspector
Clair Brown Announced 11-13/10/2005 at 10:00hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ashcroft House Address Fairview Close, Wilderness Hill, Cliftonville, Kent. CT9 2QE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 296626 01843 571551 Mr C Osman Registered Care Home 88 Category(ies) of Older Persons (39) Dementia - over 65 (49) registration, with number of places Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 02/08/04 Brief Description of the Service: Ashcroft House is an exceptionally large detached property, that was previously a hospital, with three floors, which have additional wings, currently the top floor is closed whilst the company considers refurbishment requirements. The Home offers a mixture of care provisions; residential, nursing and dementia. The home is situated within walking distance of local amenities. There is a shaft lift to access the upper levels. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by two inspectors and the duration of the inspection was 14 hours over three days. The Homes representative was the acting manager and a company representative. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 3 service users, 7 staff, 2 relatives and 2 visiting health & social care professionals, to gain their views. Some staff were actively involved in the inspection. Time was also spent observing interaction between staff and service users. Seventeen service users and fourteen relatives completed inspection comment cards. A full tour of the premises was conducted, documents and records were examined, service users files were case tracked and one floor had a medications checked. What the service does well: What has improved since the last inspection?
There has been a change in the way the home has been managed over the last six months. One of the company directors has taken a back seat and another director has been spending more time at the home. There has been a positive response by this new management to resolve the outstanding requirements from previous inspections. There has been a marked improvement in the atmosphere of the home and the overall quality of care provided; this is most evident on the first floor where those with dementia are cared for. The specific needs of those with dementia have been acknowledged and acted upon. In this area the environment has been decorated to support the care and to reduce conflict between service users, such as painting bedroom doors the
Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 6 same colour as the walls. Screening has now been provided in shared bedrooms. Additional ancillary staff have been employed resulting in care staff no longer being required to perform those duties and are now able to focus on the care aspect of their work. This has had a positive affect on the service users quality of life and staff morale has increased as a result of this. Designated activities persons have been employed and now provided a range of activities. Medication practices on the ground floor have improved. The management of the laundry and the procedures used have improved with additional staff and bed linen being handled by a contractor. The overall levels of cleanliness around the home were good. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,6 The statement of purpose and service user guide does not provide adequate information to enable prospective service users to make an informed decision. Prospective service users are assessed but information gathered and recorded is insufficient. EVIDENCE: The statement of purpose and service users guide do not contain all of the information required. Previous requirements have not been met to amend these documents so that they contain all the details specified. The statement of purpose is not user friendly and some information is inappropriate, such as a staff guidance on abuse and a procedure for dealing with death. Although pre– admission assessments are conducted and details recorded, the information gathered was inadequate and vague. Thirteen of the relatives comment cards completed stated they were happy with the overall quality of care provided and three added comments to say how kind and caring the staff are. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Although improvements have been made the care planning system is still inconsistent and does not adequately provide staff with the information they need to satisfactorily meet service users needs. There is evidence that appropriate action is taken to ensure that health needs are met. Medication procedures and practices have improved. EVIDENCE: Although the quality of some care plans and records have improved since the last inspection these documents continue to fail to identify all of the service users care needs. One service users file contradicted itself as to whether or not the service user was catheterized. Another failed to identify that the service user had diabetes when writing about diet on the care plan. On the first floor where those with dementia are cared for, the care plans provided a reasonable picture of care needs and gave a “feel” for the person, although more detail about action needed is required. The ground floor medications were audited. There were only minor errors found and staff demonstrated a good understanding of procedures. Information received in the service users’ comments cards indicates that thirteen service users felt their privacy was not always respected.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Improvements have been made to the provision of meaningful and a varied range of activities. Mealtimes are close together and timed for the benefit of the home and kitchen staff. EVIDENCE: Since the last inspection experienced activities staff have been employed. A selection of activities have been introduced both in groups and on an individual basis, this was most evident in the area of the home designated for caring for those with dementia. The atmosphere in this area of the home has changed and is now more relaxed and calmer. The mealtimes were very close together with only a short space between each meal but then a long gap from the last meal of the day to breakfast time. Within 8 ½ hours all three main meals of the day had been served. Some of this practice was historical and the other aspect affecting this was the time the cooks’ shift finished. The catering budget is low and would benefit from being reviewed. The new manager and company representative made a commitment to review meal arrangements following discussion at the inspection. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Improvements have been made to the environment to raise the standard of living for service users and the working environment for staff, although further work is required. EVIDENCE: Changes have been made to the décor, which discourages service users with dementia entering other service users bedrooms reducing confrontation between service users; this was to paint the doors to match the walls. Other features now include an internal “bus stop” which has reduced service users pacing up and down the corridors, now they will sit at the bus stop and enjoy a chat with another service user. The overall refurbishment of the building has been recommenced with unfinished work being completed and bedrooms and communal areas being decorated. The quality of the bedroom furnishings is tired and worn and therefore needs replacing. Changes have been made to improve the transportation of dirty linen to the laundry and the provision of
Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 14 additional staff in this area has greatly improved this facility. Designated activity areas have been created. Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Care staff are provided in sufficient numbers to meet the needs of the service users. The changes to the roles and responsibilities of both care staff and ancillary staff has improved the quality of life for service users and raised staff morale. Recruitment procedures are not thorough and do not ensure the safety and welfare of the service users. Staff do not have sufficient training and skills to meet service users needs. EVIDENCE: The Home currently employs 1 manager, 2 heads of care, 7 registered nurses, 32 care staff 3 activity co-ordinators, 10 housekeeping staff, 11 kitchen staff (some of whom are meal time assistants), 2 administrators and 2 maintenance staff. Between the two floors there are between 9 and 11 staff on duty during the days, plus 2 mealtime assistants. On nights there are 5 care staff and 1 registered nurse. There has been an increase in ancillary staff who now have clearly defined roles which removes the need for care staff to perform ancillary duties leaving them available to provide care. Staff spoken to expressed how they feel a lot happier with this and that they can do their job properly. Only four care staff have completed the NVQ level 2 in care with a further 19 staff enrolled on the course. Planned training includes in-house training in; food hygiene, moving and handling, health & safety and dementia. Currently very few staff have dementia training. Staff files provided evidence that staff are employed without CRB and POVA checks being conducted until after they have started work.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34,35,36,37,38 The management have made significant improvements to the home since the last inspection. The manager has a good understanding of the areas in which the home still needs to improve. EVIDENCE: A new manager has recently been appointed who is currently shadowing the company representative who has been managing the home for the last six months. The change in management approach has benefited both staff and service users. There has been further investment in the building as well as in additional staff; which includes activities persons. Staff meetings have been reintroduced and the management acknowledged the need to pay staff if they attend to encourage attendance. Work has been done on team building strategies to establish a stable work force. The environment health & safety certificates were in order but the environmental and fire risk assessments are not sufficiently detailed and have not been kept under regular review.
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This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 2 3 3 2 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 3 x 3 2 2 2 2 Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14,15 Requirement Thorough and detailed preadmissions assessments must be conducted and recorded for all prospective service users. previous requirement: 30.11.04 Care plans must be more detailed in some areas; for example, skin integrity assessments and specific details about providing care, such as fluid intake, personal care, movement & handling needs. Reviews must be conducted regularly and be a true review of assessed needs. Daily reports must record all aspects of care provided and be linked to the care plan. previous requirment: 31.12.04 A new schedule of accommodation must be submitted the CSCI whenever changes are made to the environment. An action plan including timescales must be submitted to the CSCI for the replacement of old, worn out furniture. To include wardrobes, beds, drawer units, bedside tables and chairs. Sufficient numbers of adjustable Timescale for action 13.01.06 2. OP7,8 12,13,14, 15, 16 31.03.06 3. OP19 13,23 31.03.06 4. OP24 12,13,14, 16,23 31.03.06 Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 21 5. OP29 7,9,19 schedule 2 6. OP30 12,18 7. 8. OP31 OP32 7,9,10,12 5,10,12, 18,21,24 4,12,13,1 6,17,23 schedules 3,4 10, 12, 15,24 9. OP38 10. OP33 11. OP1 4, 5 schedule 1 beds must be provided for those needing nursing care. (1)Recruitment procedures must be thorough, exploring gaps in employment history, interview records must be completed and POVA and CRB checks must be completed before employment starts. (2)To contact the Home Office to confirm the need to identify work place on the work permits. (1)Induction programmes must be completed by all new staff with topics covered in depth. Previous requirement:14.04.04 (2)All staff must have completed basic dementia training. Care staff must complete a more advanced dementia training programme. An application must be made to register a manager with the CSCI The owners must formally notify the CSCI about the long term overall management of the Home. The fire risk assessment and environmental risk assessments must be more detailed and kept under regular review. For the Home to develop and implement an annual quality monitoring system. Producing a report, copy must be sent to the Commission. previous requirement: 30.04.05 The Statement of Purpose and Service Users Guide must be amended to include all of the required information. previous requirement:31.12.03,11.04.04, 28.02.05 (1) 05.12.05 (2) 13.01.06 (1) 13.01.06 (2) 30.06.06 31.03.06 13.01.06 13.01.06 30.06.06 13.01.06 Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations To review meal times, so that meals are provided more evenly throughout the day. For a review of the service users food budget to be conducted, to ensure appropriate nourishment and choice. That the training programmes recently developed and introduced are developed further. The procedures to be reviewed for the management of service users monies. To reintroduce formal supervision on a regular basis for all staff. 2. 3. 4. OP30 OP35 OP36 Ashcroft House H56-H05 S40622 Ashcroft House V247160 111005 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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